Summary

In this episode, the hosts introduce Sitaram Chilakamarry, MD, a colorectal cancer specialist, and discuss his background and interest in medicine. They then delve into the topic of colorectal cancer, providing statistics on its prevalence and mortality rates. They explain the anatomy of the colon and rectum and how colorectal cancer develops from the innermost lining of these organs. The discussion also touches on the role of genetics, diet, and inflammation in the development of colorectal cancer. The hosts emphasize the importance of early screening and detection to prevent advanced stages of the disease. The conversation explores different screening methods for colorectal cancer, including stool-based tests and direct visualization tests like colonoscopy. The FIT test, which checks for blood in the stool, is the most popular stool-based test. Colonoscopy is considered the gold standard for screening, but it is expensive and carries risks. The conversation also highlights the importance of healthy lifestyle choices in reducing the risk of colorectal cancer. Tobacco use and obesity are significant risk factors. The incidence of colorectal cancer is higher in smokers, and smoking causes inflammation throughout the body. The conversation concludes with a discussion of different cases of colorectal cancer and the next steps in diagnosis and treatment. In this conversation, Sitaram Chilakamarry discusses the process of diagnosing and staging colon and rectal cancer. He explains the importance of MMR testing, staging with CT scans and blood tests, and the role of surgery and chemotherapy in treatment. He also highlights the significance of regular colonoscopies for early detection and the potential for non-operative management of rectal cancer. Additionally, he mentions the promising use of immunotherapy in treating rectal cancer in patients with Lynch syndrome.

Chapters

00:00 Introduction and Background

08:11 Understanding the Anatomy of the Colon and Rectum

13:08 The Development of Colorectal Cancer

24:49 The Importance of Early Screening and Detection

27:32 Exploring Different Screening Methods

36:29 The Pros and Cons of Colonoscopy

43:37 The Impact of Tobacco Use and Obesity

50:43 The Importance of Healthy Lifestyle Choices

53:49 Diagnosing Colorectal Cancer

59:28 The Significance of Screening Compliance

55:17 Staging and Blood Tests

56:45 Treatment Plan and Chemotherapy

01:04:00 Urgent Cases and Ostomy

01:08:49 Elective Cases and Surgery

01:14:07 Anemia and Colonoscopy

01:19:46 Polyps and Watchful Waiting

01:23:35 Immunotherapy and Lynch Syndrome

Takeaways

• Colorectal cancer is a common and serious disease, with approximately 150,000 new cases and 53,000 deaths in the United States each year.
• The colon and rectum are part of the gastrointestinal tract, with the colon absorbing water and the rectum acting as a reservoir for stool.
• Colorectal cancer arises from the innermost lining of the colon or rectum and is typically classified as adenocarcinoma.
• Genetics, diet, and inflammation are factors that contribute to the development of colorectal cancer.
• Screening for colorectal cancer is crucial, as early detection can prevent advanced stages of the disease. Stool-based tests like the FIT test are popular for colorectal cancer screening.
• Colonoscopy is considered the gold standard for screening but is expensive and carries risks.
• Tobacco use and obesity are significant risk factors for colorectal cancer.
• Smoking causes inflammation throughout the body, increasing the risk of colorectal cancer.
• Healthy lifestyle choices can help reduce the risk of colorectal cancer.
• Diagnosis of colorectal cancer involves checking for mutations and inherited syndromes.
• Screening compliance is important, especially for individuals with a family history of colorectal cancer. MMR testing (or mismatch repair testing) is important for diagnosing colon and rectal cancer.
• Staging involves CT scans, blood tests, and determining the depth of tumor invasion.
• Regular colonoscopies are crucial for early detection and treatment.
• Non-operative management may be an option for rectal cancer patients with a complete clinical response.
• Immunotherapy shows promise in treating rectal cancer in patients with Lynch syndrome.